Historical Note
THEORIES OF HYSTERIA*
THOMAS A. H.
The word hysteria derives from the
Greek by stera (uterus). From this is de-
rived the Hippocratic theory that hys-
teria was caused by the uterus wandering
about the woman's body as a free organ,
and hysteria was thus limited to women.
It was not considered to be a mental
disease. Plato adhered somewhat to this
theory and wrote in Timaeus that the
uterus, becoming angry at remaining un-
fruitful, wandered throughout the body
and closed up the passages of the breath,
and, by obstructing respiration, caused all
varieties of disease.
Aretaeus of Cappadocia in the second
century A.D. believed the disease to be
limited to women and that it was due to
the migration of the uterus which com-
pressed the intestines, giving a choking
sensation after the form of epilepsy. Little
change in the theory of hysteria took
place until the time of Galen, some seven
centuries after Hippocrates. Hysteria
came then to be thought of as a local
suffocation of the uterus and not the
wandering of it.
During the Dark Ages, possession by
the devil was the keynote to hysteria,
with an elaborate system of hunting out
the possessed by looking for the so-called
'stigmata',-naevi, pigmented spots and
anesthesias. With the Renaissance, Para-
celsus stated "Mental diseases have noth-
ing to do with evil spirits or devils" and
used the name chorea lasciua or lascivious
dancing for hysteria, thus suggesting the
sexual nature of the disease. In the seven-
teenth century, Charles Lepois insisted
that the cause of hysteria should be
sought not in the uterus but in the brain
"Post-graduate semmars in the history of psychiatry
(Prof. Edward L. Margetts) , Department of Psychiatry,
Faculty of Medicine, The University of British Columbia,
Vancouver, Canada. Seminar 5 October 1962.
""Revised Nov. 1965. E.L.M.
'Surgeon-Commander, Resident in psychiatry
(1962-3), Shaughnessy Hospital, Vancouver, B.C.
Canad. Psychiat. Ass. J. Vol. 14 (1969)
MCCULLOCH, M.D:
and that therefore it was also a disease of
men. This was implied by Thomas Willis
in his advocation of restraint, blows and
fetters to induce the mind to give up its
arrogance and wild ideas and become
meek and orderly. Others, however, still
considered the localization of 'hysteria'
in the genital area and Lazare Riviere
( 1660) wrote chapters entitled De hy s-
terica passione and De furore uterino.
William Cullen (18th century) accepted
the Hippocratic theory and thought
hysteria was due to a displacement of the
uterus (particularly the ovary) to the
brain which causes convulsions, but
could offer no explanation as to how this
occurred.
It became the custom to prescribe
sweet-smelling concoctions at the per-
ineum to attract the uterus back into
place and to give evil tasting medica-
tions 'at the other end' (by mouth) in
order to repel the uterus back to its pro-
per place. Sydenham theorized that hys-
teria in females and its counterpart,
hypochondriasis in males, arose "from a
disorder (ataxy) of the animal spirits".
Franz Anton Mesmer added a new
impetus to the theory of hysteria through
the interest of John Elliotson and James
Braid. The former felt mesmerism was
especially useful in hysteria and stated it
was the treatment of choice since
"... (hysteria) is not necessarily con-
nected with the uterus, nor confined to
the female sex, but occurred frequently
both in boys and men." The latter wrote
a treatise called Neurypnology or the
rationale of nervous sleep (1843) and
wrote that ansesthesia, automatic obedi-
ence and the phenomena of sleep could
be explained on the basis of psychological
processes. Franz Joseph Gall of Vienna,
on the basis of 'organology' and 'crani-
635
636 CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
oscopy', the forerunner of 'phrenology',
advanced the theory that the seat of
hysteria lay in the cerebellum because
this was the seat of carnal knowledge.
The development of neurology raised
the conception of the 'nervous' patient
to a more respectable and scientific basis,
and there was a shift of emphasis from
the uterus to that of the nervous system.
This was well summed up by Paul Briquet
(1859) who did not believe there was a
causal connection between sexuality and
hysteria.
Under the influence of both hypnotism
and neurology, Jean Martin Charcot (late
19th century) considered the basis of
hysteria to be physical and organic, com-
bined with heredity, but still stated that
it was to the ovary and the ovary alone
that one had to look for the source of
the fixed iliac pain of hysterics. He con-
cluded that the states observed under
hypnosis could only be induced in those
people who suffered from hysteria. Al-
though well aware of auto-suggestion and
the psychological aspects of hysteria, he
believed these were due to organic
pathology and heredity. In collaboration
with Paul Richer he unravelled the
puzzle of demoniacal possession by point-
ing out that demoniacal possession as re-
flected in art was typical of hysteria.
Ivan Petrovich Pavlov (early 20th
century) postulated that hysteria was the
result of conflicting, overwhelmingly
strong or weak repetitive stimuli imping-
ing on a balanced mechanism of condi-
tioning but with the suggestion of physi-
cal pathology, since he divided his dogs
into types.
Hippolyte Bernheim stressed the strong
influence of suggestion and auto-sugges-
tion in the production of the hysteric's
symptomatology, and solved the riddle of
the stigmata by pointing out that it was
due to suggestibility and to the free reign
of the imagination of the 'witches' and
the patients. Joseph Babinski further
pointed up the role of suggestibility and
Vol. 14, No.6
persuasion by coining the term pithiatism
which is derived from Greek roots peitbo
(I persuade) and iatos (curable).
Joseph Breuer noted that cure of symp-
toms occurred when he allowed patients
to talk while under hypnosis and to relate
what was oppressing their mind. As early
as 1880 he stated that hypnosis allowed
of a glimpse into the deeper layers of the
psychopathological processes. He and
Sigmund Freud developed the idea that
any experience which roused the dis-
tressing effects of fright, apprehension,
shame or psychical pain could produce
hysterical symptoms, and that the
hysteric suffered from painful reminis-
cences. They explained hysteria on a
physical neurophysiological basis, on ex-
citation in the nervous system, with emo-
tional and motor discharge or with
anomalous or 'hysterical' reactions if this
discharge were blocked. Although his ex-
planation was initially organic in nature,
Freud later evolved the view that dis-
turbance of sexuality as psychic trauma,
and the repression of ideas from
consciousness were of outstanding impor-
tance in the pathogenesis of hysteria.
He considered hysterical symptoms to
be a dissociation of painful ideas from
consciousness by a psychic force for the
purpose of defence against mental pain.
The ideas, being incompatible with
consciousness, were converted into symp-
toms. These ideas, he believed, were pre-
dominantly sexual and repressed out of
consciousness.
Pierre Janet concluded that in hysteria
ideas became dissociated from each other.
They become isolated from conscious-
ness, fixed because of exhaustion of the
higher functions of the brain and the
lowering of nervous strength, the result
of a weakened nervous system of a con-
stitutional nature, from heredity and
degeneracy. In contrast to the constitu-
tional weakness theory of Janet, Carl
Jung considered hysteria to be an exag-
geration of the normal attitude which
December, 1969 HISTORICAL NOTE 637

was complicated by compensatory re- considered due to the wandering of the

actions from the unconscious, which
showed its opposition to the extravagant
extraversion by developing physical
symptoms.
The theories of hysteria commenced
with and have ended with a sexual con-
notation. In the beginning, hysteria was
uterus and confined to women. It was
then thought to be the result of organic
changes in the nervous system. Recent
theory explains the illness on the basis of
repressed disturbances of sexuality, and
recognizes that men also may suffer
from it.

Noone who is not female can be in a position

to make accurate statements about women.
.Sex and Character
Otto Weininger
1880-1903